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In Reply: Dr Minneci and colleagues suggest that potential publication bias may have influenced the results of our meta-analysis. Testing the asymmetry of the funnel plot (Figure) as proposed by Egger¹ suggests significant asymmetry (P = .01). However, because of mathematical links between the log odds ratio and its standard error, the Egger method may produce a false-positive result.²

Figure appears in full text version. Figure. Funnel Plot Scatterplot of the intervention effect estimates (log risk ratio [RR]) from the 12 individual studies on prolonged treatment with low-dose corticosteroids against each study precision (standard error of log RR). Lines define areas according to significance levels (1%, 5%, and 10%). Because the precision of the intervention effect estimate is proportional to the study's size, effect estimates from small studies scatter more widely at the bottom of the graph, with the spread narrowing among larger studies.

The potential sources of an asymmetrical funnel plot include selection . . . [Full Text of this Article]

Djillali Annane, MD, PhD
djillali.annane@rpc.aphp.fr
Critical Care Department
Hôpital Raymond Poincaré (AP-HP)
Garches, France

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